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450HT�8� � <br /> Applicatic o��ssiakF� <br /> f -FOR- <br /> Cet fieate of Appropriateness _° <br /> \� RE�ACB�j m <br /> HISTORIC PRESERVATION COMhIISSION s <br /> 1865 of SOUTH BEND&ST.JOSEPH COUNTY <br /> 125 S.Lafayette Blvd.,South Bend,IN 46601 <br /> httpd/www.st osePhcoun4indiana.com/departments/SJCHPTmdex•htin <br /> p:574-235-9798 f 574-235-9578 e:SBSJCBPC@co.st-josephin.us <br /> OFFICE USE O)VLPy»»>AO NoT COMPLETE A11TY iR CONTAIIVED IN 1HE5 BOX«««OFFTC USE ONLY <br /> [DaR ved: 7j©�7 Application Number: ' �7 i l — <br /> ws: YES (DvenftasrRnien) �'I LI I ,1�L (/ El NO <br /> oval authorized by: Title• <br /> ese rvation Commission Review Dater® Local Landmark ElLocal Historic District(N=e)El National Landmark National Register District(Name) <br /> of Appropriateness: <br /> Denied 11 Tablgd F1 Sent To Committee <br /> Approved and issued: <br /> (Please Print) <br /> Address of Property for proposed work: <br /> (Street Number-Street Nmne-Cui --Zip Code) <br /> Name of Property Owner(s): <br /> r- "eir- �/ Phone 7o y- 3 <br /> Address of Property Owner(s): _�at <br /> (Street Number-Street Name, -Qty-Zip Code) <br /> Name of Contractor(s): d1_4 Phone#: Vx - <br /> Contract Company Name: —ZL ue/ e!5 '/'?I q_ /.e <br /> Address of Contract Company: /01- &- J x VK <br /> (Street Number Street Nmne--Gttp-Zip Code) <br /> Current Use of Building: <L"a /ham W-ej'?, ( <br /> (Single FwW4-Multi-Famt4-Commercial--Government-Indus&wl-Vacant-etc.) <br /> Type of Building Construction: <br /> (Wood Frame-Brick-alone-Steel--Concrete-Other) <br /> Proposed Work: In-Kind Landscape Fj New Replacement(not in-kind) Demolition <br /> (more than one bax may be checked f / <br /> Descriptionyf Prop ed Work: 4/l3` ) h w", � G✓GS�' ` <br /> F F <br /> /`P�ilr<n�, So::�j1 b,Jr i�/'t i-*�&•L( if yc..! in ate+fy" -,-f`� t+—i�. �/',t" <br /> C"r7-\i t,KJ <br /> Owner/Contractor Fax#: e-mail: `j / a// / <br /> (Staff will correspond with only one designee) �S 7`�?p' /�.5� S/� <br /> � l <br /> X l� �f1✓� and/or X <br /> Signature of Owner Signature of Contractor <br /> A DDT Tt'A WnM DVC%TTMVhX %PV4-'+ ADTP T TC'PL it&-%AT DQTTrTDOC oy"V <br />